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Implications for Coverage Expansion Efforts

Implications for Coverage Expansion Efforts . Sarah Muller September 2010. Outline . Overview of Santa Clara County Who Will be Eligible for Health Coverage Under National Health Reform? Affordability Preparing for Implementation: Issues to Consider.

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Implications for Coverage Expansion Efforts

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  1. Implications for Coverage Expansion Efforts Sarah Muller September 2010

  2. Outline • Overview of Santa Clara County • Who Will be Eligible for Health Coverage Under National Health Reform? • Affordability • Preparing for Implementation: Issues to Consider

  3. Health Insurance Programs Available to Santa Clara County Residents • Children: Medi-Cal, Healthy Families, Healthy Kids • Adults: • Medi-Cal (limited to pregnant women and the disabled) • Healthy Workers (enrollment began in March 2010- provides affordable health insurance for low-middle income workers in small businesses) • Medicare

  4. Uninsured in Santa Clara County • Santa Clara County uninsured: 200,000 • Recent UCLA report indicated up to 314,000 uninsured • Income: at least 130,000 are under 300% of FPL ($32,500/yr) • Racial demographics: 68% are Latino or Asian, 25% White • Gender: Male 56%, Female 44% • 71% of the uninsured are working at least 20 hours per week

  5. Why are the Number of Uninsured Increasing? • Rising premiums: • Between 2000-2009 health premiums rose 130% • Fewer employers are offering affordable employer-based health insurance • Only 38% of low-middle income adults had health coverage on the job • Worker premium contributions rose from $1,477 to $3,308 (2000-09) • Individual health insurance is often too expensive for low and middle income families • Economic Recession

  6. National Health Reform- Overview • Dramatic expansion of health care coverage for adults • New subsidies available to low and middle income families • Insurance market reforms to make health care coverage more accessible • Employer mandate for large employers/ tax credits for small employers • Individual mandate: Everyone will be required to purchase health coverage • Hardship exemptions will be made for some individuals • Undocumented immigrants exempt from mandate

  7. How Will National Health Reform Impact the Uninsured in Santa Clara County? • Expanding health care coverage: • 48k eligible for Medi-Cal • 90-100k eligible for subsidized health coverage • 46k remaining uninsured

  8. Affordability on the Insurance Exchange • Premium contributions will be limited based on income: • 150% of FPL($16,245): $68/month • 200% of FPL ($21,660): $113/ month • 250% of FPL ($27,075): $191/month • 300% of FPL ($32,490): $257/month • Hardship exemption: will be available to individuals whose lowest cost plan option exceeds 8% of an individual’s income

  9. Preparing for Health Reform Implementation: Issues to Consider • Opportunities for the Santa Clara Valley Health and Hospital System • Preparation for Medi-Cal eligible population • Coverage option with public providers? • Coverage does NOT equal Access • Need to develop strategies to address the ongoing needs of those left behind: undocumented, mentally ill/ homeless that will still be hard to insure

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